Dr. Jacqueline Gerhart: Varicose Veins Not Uncommon, But Can Be Painful

Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.

This week I am writing about a question from one of my own patients.

Dear Dr. Gerhart: Why do I have so many varicose veins, and could they be causing me to have leg pain? Should I get them removed?

Dear Patient: Varicose veins, or "varicosities," are veins that are swollen and raised above the surface of the skin. They are the most common on the lower legs and the inner thighs. They affect more than 50 percent of people over the age of 50 and often worsen with age.

They are more common in women - perhaps because women cross their legs more than men do, which is one of the risk factors for varicose veins. Other risks include a sedentary lifestyle, standing for long periods of time and wearing tight clothing that puts pressure on your skin.

So why are they so bumpy? Varicose veins develop when valves in the veins stop working. Since the job of veins is to return blood to the heart, if the valves stop working, blood pools in the veins, causing them to become larger and bulge out. As a result, varicosities are created.

Usually varicose veins do not cause major health problems. Sometimes, however, they can cause pain, blood clots or skin ulcers. In most cases treatment is not needed. Hemorrhoids - one specific type of varicose veins - can cause other problems such as itching, irritation or bleeding. If these symptoms develop, treatment may be warranted.

For hemorrhoids, a cream like Preparation H can be used for mild irritation. Moderate irritation requires a prescription cream and may require a small procedure that can be done in the office of your primary care physician. Treatment of moderate to severe pain or bleeding usually requires a surgery consultation.

If you do elect to treat varicose veins on your extremities - either for symptoms or for appearance - you have multiple options. First is lifestyle change. Begin activities that get your legs moving and that tone your leg muscles. Avoid standing or sitting for long periods of time. When sitting, don't cross your legs. When resting, try to elevate your legs above the level of your heart.

If you are overweight, losing weight also will improve the blood return to your heart. And, ladies, avoid tight clothing and high heels that may cut off circulation. Men, you also should stay away from higher heels.

Next are non-procedural therapies. Compression stockings, which can be purchased in varying degrees of tightness, provide pressure and support. They help veins stay below the skin surface and decrease leg swelling. If you have overall leg swelling and high blood pressure, a diuretic or "water pill" medication also might be helpful.

Procedural therapies include those that remove the varicose veins and those that close them off to blood flow.

Ways to close the veins off from blood flow are:

Sclerotherapy: Injecting a chemical into the vein to scar it.

Ablation: Using radiowaves to create heat to close it.

Endoscopic surgery: Maneuvering a tiny camera through the veins to close them.

Ways to remove the veins are:

Phlebectomy: Removing small veins through cuts in the skin. This is done under local anesthetic, in which the patient is awake for the procedure.

Vein stripping: Removing more extensive veins, usually under general anesthesia where the patient is put to sleep.

Laser therapy: Using light energy to fade the veins.

For further information consider consulting a vascular surgeon, plastic surgeon or certified medical professional with experience in varicose veins.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.